Emergency care assessment, psychological considerations

Emergency care

Emergency care can be defined as the episodic and crisis-oriented care provided to patients with serious or potentially life-threatening injuries or illnesses

EMERGENCY ASSESSMENT

Initial Assessment: Form a general impression of the patient

Assess the Patient's Mental Status:

Classify the patient's mental status into one of the following categories:

·        Alert

·        Verbal

·        Painful

·        Unresponsive

The primary survey: Mnemonic ABCD

Airway

·        Does the patient have an open airway?

·        Is the patient able to speak?

·        Check for airway obstructions such as loose teeth, foreign objects, bleeding, vomits or other secretions.

·        Treat immediately

Breathing

·        Is the patient breathing?

·        Assess for equal rise and fall of the chest

·        Respiratory rate and pattern     

·        Skin color

·        Use of accessory muscles

·        Integrity of the chest wall

·        position of the trachea.

Circulation:

·        Palpate a central pulse?

·        What is the quality (strong, weak, slow, rapid)?

·        Is the skin warm and dry?  

·        Is the skin color normal?

·        Obtain a blood pressure

Disability:

·        Assess level of consciousness and pupils

·        Assess level of  by GCS scale:

·        Is the patient alert?

·        Does the patient respond to voice?

·        Does the patient respond to painful stimulus?

·        The patient is unresponsive even to painful stimulus.

Secondary Assessment: Mnemonic:"EFG"

Expose

Head, neck, Chest, Abdomen

Examine for any injuries

Environmental control: prevent heat loss by using warm blankets, overhead warmers, and warmed I.V. fluids

Full set of vital signs

·        Obtain a full set of vital signs

·        obtain blood pressure in both arms if chest trauma is suspected.

Five interventions

·        cardiac monitoring 

·        pulse oximetry to measure the oxygen saturation

·        Indwelling urinary catheter

·        gastric tube

·        Laboratory studies

Ø Blood group and cross matching

Ø hemoglobin and hematocrit

Ø urine drug screen

Ø blood alcohol,

Ø electrolytes

Ø prothrombin time (PT) and partial thromboplastin time

Ø pregnancy test if applicable

Facilitate family presence

If any member of the family wishes to be present-during-the-resuscitatjon, it is imperative to assign a staff member to that person to explain what is being done and offer support

Give comfort measures: verbal reassurances as well as pain management.

          Focused History & Physical Exam - Trauma

·        Re-evaluate Mechanism of Injury (MOI) 

·        Significant MOI? Yes/No

o   Is patient unresponsive or disoriented?        

·        Is patient under the influence of drugs or alcohol?

·        Patients with Significant MOI

RAPID TRAUMA ASSESSMENT

DCAP-BTLS

·        D - Deformities

·        C - Contusions

·        A - Abrasions

·        P - Punctures/Penetrations

·        B - Burns

·        T - Tenderness

·        L - Lacerations

·        S -Swelling

Quickly Obtain Baseline Vital Signs

S-A-M-P-L-E History

S - Signs & Symptoms

A – Allergies: Medications, Foods, Environment

M - Medications

·        Are you taking any?

·        When did you last take your medication?

·        What are they?

·        What are they for?

·        May I see them?

P - Previous Medical History

·        Pertinent

·        Related to this complaint

·        Complicating factor

L - Last Oral Intake Food and/or Drink?

·        What?

·        When?

E - Events leading up to the incident

·        What happened?

·        When?

Physical assessment

Head-to-Toe Assessment patient's general appearance, including body position or any guarding or posturing.

Head and face

·        Inspect for any lacerations, abrasions, contusions, puncture wounds, ecchymosis, edema Palpate for crepitus, crackling, or bony deformities.

Chest:

·        Inspect for breathing effectiveness, paradoxical chest wall movement, disruptions in chest wall integrity.

·        Auscultate for bilateral breath sounds and heart sounds

·        Palpate for bony crepitus or deformities

Abdomen/flanks

·        Inspect for lacerations, abrasions, contusions, puncture wounds, ecchymosis, edema, scars or distention.

·        Auscultate for the presence of bowel sounds.

·        Palpate for rigidity, guarding, masses, or areas of tenderness Pelvis/perineum

·        Inspect for lacerations, abrasions, contusions, puncture wounds, ecchymosis, edema, or scars

·        Look for blood at the urinary meatus.

·        Palpate for pelvic instability and anal sphincter tone

Extremities

·        Inspect skin colour and temperature.

·        Look for signs of injury and bleeding.

·        Does the patient have movement and sensation of all extremities?

·        Palpate peripheral pulses

·        Bony crepitus Areas of tenderness

·        Posterior surfaces

·        Inspect for possible injuries-

·        Palpate the vertebral column and all tenderness

Focused Assessment

Any injuries that were identified during the primary and secondary sunseys require a detailed assessment.

PSYCHOLOGICAL CONSIDERATIONS

Approach to the Patient

·        Understand and accept the basic anxieties of the acutely traumatized patient.

·        Understand and support the patient's feelings concerning loss of control.

·        Treat the unconscious patient as if conscious.

·        Avoid making negative comments about the patient's condition. Be prepared to handle all aspects of acute trauma know what to expect and what to do.

Approach to the Family

·        Inform about patient admission unit

·        Give as much information about the treatment.

·        Allowing a family member to be present during the resuscitation.

·        Recognize the anxiety of the family

·        Acknowledge expressions of anger, guilt, and criticism. Deal with reality as gently and quickly as possible Avoid encouraging and supporting denial.

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